Abstract
Purpose: Thalamic atrophy and whole brain atrophy in multiple sclerosis (MS) are associated with disease progression. The motivation of this study was to propose and evaluate a new grouping scheme which is based on MS patients' whole brain and thalamus volumes measured on MRI at a single time point.Methods: In total, 185 MS patients (128 relapsing-remitting (RRMS) and 57 secondary-progressive MS (SPMS) patients) were included from an outpatient facility. Whole brain parenchyma (BP) and regional brain volumes were derived from single time point MRI T1 images. Standard scores (z-scores) were computed by comparing individual brain volumes against corresponding volumes from healthy controls. A z-score cut-off of −1.96 was applied to separate pathologically atrophic from normal brain volumes for thalamus and whole BP (accepting a 2.5% error probability). Subgroup differences with respect to the Symbol Digit Modalities Test (SDMT) and the Expanded Disability Status Scale (EDSS) were assessed.Results: Except for two, all MS patients showed either no atrophy (group 0: 61 RRMS patients, 10 SPMS patients); thalamic but no BP atrophy (group 1: 37 RRMS patients; 18 SPMS patients) or thalamic and BP atrophy (group 2: 28 RRMS patients; 29 SPMS patients). RRMS patients without atrophy and RRMS patients with thalamic atrophy did not differ in EDSS, however, patients with thalamus and BP atrophy showed significantly higher EDSS scores than patients in the other groups.Conclusion: MRI-based brain volumetry at a single time point is able to reliably distinguish MS patients with isolated thalamus atrophy (group 1) from those without brain atrophy (group 0). MS patients with isolated thalamus atrophy might be at risk for the development of widespread atrophy and disease progression. Since RRMS patients in group 0 and 1 are clinically not distinguishable, the proposed grouping may aid identification of RRMS patients at risk of disease progression and thus complement clinical evaluation in the routine patient care.
Highlights
To lesion burden as a marker for disease activity, brain atrophy measured by magnetic resonance imaging (MRI) has in recent years been established as an important biomarker of tissue damage and neurodegeneration in multiple sclerosis (MS) [1,2,3,4]
55 patients were scanned on the Philips Achieva 3 T scanner system and 130 MS patients were scanned on the GE Signa 3 T scanner system
MRI-based brain volumetry at a single time point was applied to MS patients from clinical routine patient care to evaluate its potential to complement clinical assessment in identifying MS patients at risk of disease progression
Summary
To lesion burden as a marker for disease activity, brain atrophy measured by magnetic resonance imaging (MRI) has in recent years been established as an important biomarker of tissue damage and neurodegeneration in multiple sclerosis (MS) [1,2,3,4]. Several studies showed an association of whole brain atrophy with worsening of the Expanded Disability Status Scale (EDSS) as a measure of physical disability [6,7,8]. A recent review summarizes that brain atrophy in both cross-sectional and longitudinal studies predicts disability progression and is associated with cognitive impairment [1]. Several longitudinal [16, 17] studies as well as a cross-sectional study [14] showed that thalamic atrophy is associated with progression of disability in MS patients, while some other studies found only a weak [10] or no association between thalamus volume and the EDSS [18]. Measures of both whole brain and regional subcortical thalamus atrophy could help to predict a worsening of clinical symptoms in individual MS patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
